Survey to Solicit Feedback on TA on Worker Safety and Health provided as part of COVID response

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0953 can be found here:

Documents and Forms

Document Name Document Type
Survey to Solicit Feedback on TA on Worker Safety and Health provided as part of COVID response Form
Field TA Survey Attachment 1. Field TA survey_updated.pdf Form
Virtual TA Survey Attachment 2. Virtual TA survey_updated.pdf Form
Generic_Clearance_Submission_TA Survey WSH COVID response 11.2.20.docx Request for Approval IC Document
Attachment 3. First email with link to survey_11.12.docx First email with link to survey IC Document
Attachment 4. Second email with link to survey_11.12.docx Second email with link to survey IC Document

Information Collection (IC) Details

IC Title:	Survey to Solicit Feedback on TA on Worker Safety and Health provided as part of COVID response	Agency IC Tracking Number:	0920-0953-21AZ

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Field TA Survey	Attachment 1. Field TA survey_updated.pdf		Yes	Yes	Fillable Fileable
Form	none	Virtual TA Survey	Attachment 2. Virtual TA survey_updated.pdf		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Worker Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,200	1,200
Annual IC Time Burden (Hours)	240	240
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	Generic_Clearance_Submission_TA Survey WSH COVID response 11.2.20.docx	11/12/2020
First email with link to survey	Attachment 3. First email with link to survey_11.12.docx	11/12/2020
Second email with link to survey	Attachment 4. Second email with link to survey_11.12.docx	11/12/2020

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.